Lazaryan et al identified factors associated with overall survival for a patient with an ampullary adenocarcinoma without distant metastases. These can help to identify a patient who may benefit from more aggressive management. The authors are from the Cleveland Clinic and the H. Lee Moffitt Cancer Center in Tampa.
Patient selection: ampullary adenocarcinoma without distant metastases, resected by Whipple procedure (96% R0 = complete resection with negative margins)
Outcome: 5-year overall survival (61%)
Factors associated with a worse overall survival:
(1) perineural tumor invasion
(2) ulcerated primary tumor (confirmed on histology)
(3) lymph node metastases
where:
• Leaving residual tumor (4% not R0) would seem to be a risk factor for recurrence.
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